Welcome to #COVIDMarathon from @ESICM - follow this thread for the content coming up over the next 7 hours. #FOAMed #FOAMcc #COVID19 #COVIDfoam 
A general update #covidmarathon
Evolving insights into increasing cases over time, globally. Very few reported cases in Africa over time. #covidmarathon
Total tests performed per million people. UAE tops the charts. South Korea second. #covidmarathon
The amplification phase can be varied WRT the doubling time. Containment is therefore VERY important. Delay the upsurge of patients who would require ICU. Active case finding is paramount --> isolate these cases. #covidmarathon
#COVIDmarathon Resource requirements vs Severity of disease. What does this mean for countries preparing for the surge? These disease severities are best estimates.
#covidmarathon What does getting ready mean? Some countries are more used to ID outbreaks. Screening and triage at ALL access points of healthcare system. We need to use a standardised scoring system to get an idea of disease severity. The community also needs EDUCATED.
A delay in Public Health measures = higher serious case loads. Surge actions need to be at the right time. 3 S's --> Structure, Staff, Supply... #covidmarathon
We need to prioritise evidence based care, as best we can, during this period of great uncertainty... let's look at the clinical characteristics that we do know. Research is of course, underway. Pregnant women and children tend to have milder disease burden. #covidmarathon
We need to do the basics very well. #covidmarathon
No effective antivirals as of yet. But we need to look at this further. Unwarranted use could seriously impact global supply chains etc. #covidmarathon
There are over 300 trials registered about #COVID19 - #covidmarathon - much more ongoing @Lennie333 - we need to try and contribute.
How can we use innovation to improve supply chain models? We need to think of our equipment and resources. @WHO and @UN are looking at and working on this right now. Also thinking about LEDCs. #covidmarathon
Failure to prepare is preparing for failure... #covidmarathon
Italian population older than Chinese population. Case-Fatality-Rate is similar up to 70yo amongst both populations. Testing numbers (denominators) are also different. #COVIDmarathon
Pre-crisis bed capacity in Lombardy, Italy was 750 beds.... now it's 1650.. in this one region alone. #COVIDmarathon The network was completely reorganised.
What does the data from Italy say? Here are the presentation characteristic %s. We also have seen: 81% MILD disease, 14% SEVERE disease, 5% CRITICAL disease. #covidmarathon
Looking at typical CXR and CT Scans... #covidmarathon
Massive proportion of MEN vs women are affected. The greatest number of patients are >61 years of age - but it is definitely seen in younger cohorts too. #covid19 #covidmarathon
Data analysis of the Italian Networks. Comorbidities and Respiratory Support Characteristics #COVIDmarathon #COVID19
Varied and evolving statistics since January 2020 - for ICU, Mortality and Death #covidmarathon
Quality of data is difficult in an evolving picture. Mortality does NOT describe the complexity of the clinical picture. Kaplan Meier Analysis may prove more useful. #covid19 #covidmarathon
"Anecdotally, in clinical practice >30% of patients are getting steroids" - the evolving clinical picture is very complex. It is likely that pharmacotherapy's role is limited at best. #COVID19 #COVIDmarathon
Learning from SARS and MERS. This our 3rd Coronavirus outbreak in the past 2 decades. The virus lineages are similar. SARS, MERS and COVID19 are related. #covidmarathon #covid19
Currently, there is inter-country variability in severity: #covidmarathon
Comparing #COVID19, MERS and SARS - all share ARDS as a main feature. The mortality is quite similar in MERS v COVID19 - but infectiousness is also different... Also the pathology.... #covidmarathon
A closer look at MERS... #covidmarathon
Evidence isn't looking good for steroid use in #COVID19 (but SSC has loose recommendations for their use) more evidence awaited. #covidmarathon
Median time from symptom onset to enrolment was late in this study. ?is there a role for antivirals at an earlier stage?
18% of MERS patients had bacterial co-infection and 5% viral co-infection. SARS was quite similar. Consider abx in your patients. #covid19 #covidmarathon
Can we learn from MERS? EARLY suspicion and high IPC precautions = major target for us. Take it seriously from the beginning. Proper triage, proper places for patients to be. STRICT infection control. Low thresholds of suspicion. Pre-test probability is VERY HIGH. #covidmarathon
@Lennie333 reminds us about why we need to #FlattenTheCurve #covidmarathon The basics haven't changed in >100 years! #COVID19
For every one person who has #COVID19 - they might infect 3 people... this gives an exponential spread. To stop this - we need to drive the R0 down as low as possible. @Lennie333
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